You know why you're exhausted - you're overstretched and over-committed. But is that all? Or is there a physical cause you may not have even considered? For most women, everyday fatigue comes with the territory. But if you've reached the stage where chronic, persistent tiredness has begun to interfere with your life, it's time to work out what's really going on.

Ask yourself the following:

● Do I still feel exhausted after I've had a few days of total rest?

● Is the tiredness affecting my quality of life?

● Do I wake up in the morning still tired?

● Have I lost most of my interest and pleasure in life?

● Do I feel generally low and depressed?

If you answer yes to any of these questions, you could have a medical problem that can be treated, so make an appointment to see your GP for advice. Here are some of the physical causes of fatigue...

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Take action

Always read the information leaflet that comes with your medication. If you think your medicine is the problem, make an appointment with your GP to discuss whether it's possible to reduce the drug or switch to another one. Never stop taking prescribed medication without first talking through all the options with your doctor.

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You feel lethargic and often find yourself short of breath. You may suffer from headaches and dizziness, palpitations and general weakness. Anaemia develops when your body is low in iron and doesn't contain enough oxygen-carrying red blood cells. It's estimated that up to one in four women may be at risk of anaemia, due to poor diet, heavy periods or some underlying disease that hinders iron absorption. It's one of the most common nutritional deficiencies in the UK.

Take action

● Visit your doctor, who will probably suggest a blood test to determine if your iron levels are low, in which case iron tablets may be suggested. If you are anaemic, your GP may need to do further tests to discover the underlying cause of the problem.

● Although you can buy iron supplements, remember iron can be toxic and is best taken under the supervision of a health professional.

● Increase your intake of iron - good sources are liver, red meat, fortified bread and cereals, eggs and dried fruit.

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Take action

● There's no cure for ME, but an early diagnosis improves the chances of recovery, so make an appointment to see your doctor as soon as possible.

● Stress management and relaxation techniques may also be useful, and some patients have benefited from cognitive behavioural therapy.

● Antidepressants have been shown to help relieve a range of symptoms in some patients.

● Most doctors stress that a gradual approach in returning to normal activities is vital - people with this condition who are too keen to get back to active work often suffer a relapse.

In some cases the thyroid can become overactive, speeding up all the body's systems. Symptoms include a rapid heartbeat, nervousness, irritability, weight loss and more frequent bowel movements. Instead of feeling supercharged and energetic, however, some people can feel permanently weak and wiped out.

Take action

Ask your doctor for a thyroid function test. Replacement hormones can be prescribed to get your body functioning normally again.

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Type 2 (non-insulin dependent) diabetes usually develops after the age of 40, but the symptoms can appear so gradually that, at first, you may not realise there is anything wrong. Left untreated, diabetes increases your risk of heart disease, stroke and heart failure, as well as kidney failure, nerve damage and blindness. You're at a higher risk of developing diabetes if you're overweight, have a family history of diabetes, are of Asian or Afro-Caribbean origin or have had gestational diabetes during pregnancy.

Take action

● Even if your symptoms are mild or seem vague, talk to your doctor. By the time diabetes is diagnosed, many people already suffer from some complications, such as retinal or nerve damage. Identifying the disease early and getting treatment can significantly reduce the risk of this happening.

● Some people can control their diabetes by keeping their weight within normal limits and taking regular exercise. Many need tablets to reduce their blood glucose levels, however, and some need insulin injections.

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Fatigue is probably the most common sign of mild depression, but people don't always understand how something that's all in your head can leave you feeling so physically wiped out. It can also be difficult to realise what's going on if you've been in that state for a long time.

Take action

● See your doctor, who can assess the severity of your depression and advise you about possible treatments. 

● Treatments that involve talking, such as counselling and self-help groups, or exercise can be helpful, as can a course of antidepressants.

● There's some evidence that complementary therapies, such as acupuncture, herbal medicines (including St John's wort), and aromatherapy, may help to reduce anxiety and alleviate mild depression in some people.

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Cheer-me-up remedies

Take action

● HRT is highly effective at alleviating some menopausal symptoms and protecting against osteoporosis, although it's now prescribed only for short-term use because of the increased risk of breast cancer, heart disease and stroke. Talk through the pros and cons with your GP.

● Nuts, seeds and oily fish contain essential fatty acids that may help to combat joint problems and relieve some other symptoms.

● Fibre-rich food, such as whole grains, vegetables, fruit, oats and beans, is thought to help balance hormones.

● Soya products, chickpeas, lentils and mung and aduki beans are rich in phyto-oestrogens called isoflavones, which can alleviate hot flushes and sweats.

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